Healthcare Provider Details

I. General information

NPI: 1417343559
Provider Name (Legal Business Name): DENNIS RYAN MARCELO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

234 E CAPITOL ST
JACKSON MS
39201-2418
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-1000
  • Fax:
Mailing address:
  • Phone: 601-317-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberDR.0064172
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number33695
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: